On March 26, 2019, VA Secretary Robert Wilkie testified before the Senate Veterans’ Affairs Committee about President Trump’s fiscal year 2020 budget request for the Department of Veterans Affairs, as well as the advanced budget request for fiscal year 2021. The following VA officials were also present at the hearing alongside Secretary Wilkie:
- Paul Lawrence, Under Secretary for Benefits, Veterans Benefits Administration
- Richard Stone, Executive in Charge, Veterans Health Administration
- Jon Rychalski, Assistant Secretary for Management and Chief Financial Officer, Office of Public and Intergovernmental Affairs
Importantly, VA’s budget for fiscal year 2020 increased by 9.5 percent from the previous year, reaching a total of $220 billion. The Senate Committee noted that VA is given more money than any other department in budget increases per year. Therefore, the focus of the Senate Committee is not on obtaining additional resources, but ensuring VA is using those resources effectively. Accordingly, Senate committee members raised questions regarding the budget during the hearing, while Veterans Service Organizations submitted written testimony with additional questions and recommendations.
Prior to addressing the Senate Committee’s questions, Secretary Wilkie once again emphasized that VA is now in the middle of the most transformative period in the history of the department.
Privatization of VA Healthcare
The privatization of VA healthcare has been a major concern with the VA Mission Act expected to take effect in June of 2019. The VA Mission Act is aimed towards expanding private healthcare access for veterans who experience long wait times at their VA provider or are too far away from their VA healthcare provider to conveniently receive care at those facilities. VA continues to express opposition to privatization, but Senate committee members worry that it is a strong possibility if resources are not used properly. Specifically, the healthcare portion of the fiscal year 2020 budget provides 81 percent of its resources to VA care and the remaining 19 percent to community care. However, there are currently over 40,000 vacancies in the VA healthcare system. Furthermore, the 2020 budget includes a 44 percent decrease in funding levels for construction programs. Therefore, if resources are not dedicated to increase staffing and to improve existing VA infrastructure, veterans may be effectively forced to start choosing private sector services in order to get the quality care they need. In other words, starving VA healthcare facilities will make veterans turn to community care, thereby leading to privatization. Senate committee members noted that they are not asking VA to use its resources to build new healthcare facilities, but to take care of the existing ones to prevent this shift.
Secretary Wilkie tried to maintain that privatization is not a concern as VA still has the largest healthcare system in the country, with veterans choosing VA care over private care. Nonetheless, Senate committee members continued to express that if VA is short-staffed and if facilities are not up to date, veterans will begin to leave.
Modernizing VA Healthcare
The Senate VA Committee also addressed Secretary Wilkie’s plans to modernize the VA healthcare system. Secretary Wilkie confirmed that his goal is to turn the VA healthcare system into a 21st-century administration. He noted that there is no longer an “ad hoc supply chain” in effect, meaning supplies are not only obtained at the point in which they are needed the most. Instead, VA is joining with the Department of Defense (DoD) in a computerized system for medical supplies. Secretary Wilkie also confirmed the department’s commitment to adopting electronic health records. These electronic records would be integrated with DoD’s the minute service members walk into military processing stations for service.
In another effort to modernize the VA healthcare system, Secretary Wilkie indicated that the department is consolidating over 140 Human Resources (HR) offices into 18 HR offices to ensure an even distribution of resources. Secretary Wilkie acknowledged the flaws in VA’s IT systems and noted the massive increase in the 2020 budget (i.e. $4.2 billion) dedicated to correcting these longstanding problems. Specifically, VA plans to retire two of its IT systems. By migrating these legacy systems out, Secretary Wilkie hopes to bring VA up to speed with the rest of America through “iCloud.” He stated there are approximately 8,000 employees dedicated to this transition, which he views as necessary in order to maintain the trajectory VA is on in terms of overall customer service.
Employee Hiring and Retention
As mentioned above, the large number of vacancies in the VA healthcare system has remained a concern. Secretary Wilkie indicated that the budget for fiscal year 2020 provides resources for VA to hire an additional 13,000 healthcare employees. However, Senate committee members questioned how Secretary Wilkie plans to grow VA’s workforce while simultaneously combatting attrition. He responded with some of VA’s new incentive programs including relocation reimbursement, sign on bonuses, and even medical school loan reimbursement up to $200,000. Secretary Wilkie also stated that his goal is to create an even more robust relationship with universities and the armed forces. He would like to have active duty doctors and nurses exiting service and entering into the VA healthcare system to continue to provide care for those who have served.
Blue Water Navy Veterans and Presumptive Conditions Associated with Agent Orange Exposure
Blue Water Navy veterans have been a focal point of discussions since the recent Federal Circuit decision in Procopio v. Wilkie, which granted them the same presumption of exposure to herbicides as veterans who served boots-on-the-ground in Vietnam. VA is still within the 90-day timeframe to appeal this decision to the Supreme Court of the United States. However, it was stated on multiple occasions throughout the hearing that Secretary Wilkie has recommended that VA does not appeal. The Senate members encouraged Secretary Wilkie to continue pushing for that recommendation to be endorsed as it will pave the way for Blue Water Navy veterans to get the benefits to which they are rightfully entitled.
Senate members also asked Secretary Wilkie to comment on the status of several conditions, which were recently studied by the National Academy of Medicine (NAM) to determine if they are linked to Agent Orange exposure. Specifically, for bladder cancer and hypothyroidism, NAM found “limited or suggestive” evidence of an association to herbicide exposure, an upgrade from “inadequate or insufficient” evidence which was previously found. Additionally, NAM determined that conditions with Parkinson’s-like symptoms should fall into the same “limited or suggestive category” as Parkinson’s disease itself. Finally, the recent findings also show that there is “sufficient” evidence linking the development of hypertension with Agent Orange exposure. Veterans groups have been calling on VA to add these conditions to the list of presumptive disease related to Agent Orange exposure. During the hearing, Dr. Stone noted that VA hopes to make a decision regarding the presumptive status of these conditions within the next 90 days.
Veterans Hearing Aid Access and Assistance Act
The Senate VA Committee previously met with VA in regards to the Veterans Hearing Aid Access and Assistance Act, which was passed into law in December of 2016. This Act mandates VA to determine criteria for a hearing aid specialist with the goal of integrating these specialists into the VA healthcare system. Senate members pointed out that since 2016, there has been no evidence of VA taking steps to implement this mandate. Additionally, members of the Committee asked for a response from VA regarding this matter by the date of the hearing, but have yet to receive one. In response, Dr. Stone indicated that VA has performed over 1 million visits for hearing compromised veterans with audiologists and technicians while also referring out about 38,000 visits per year. The question VA is still trying to answer is whether it needs to move this health issue into a specialist area. Dr. Stone maintained that there are currently enough audiologists and technicians to provide the vast majority of care, establishing less than a 10-day waiting period for care or hearing aid appliances. However, VA will look to respond further to the Senate VA Committee’s mandate.
Veterans Suicide National Task Force
During the hearing, Secretary Wilkie also spoke about leading the Veterans Suicide National Task Force and his efforts to establish public-private partnerships in order to address this important issue. He noted that the fiscal year 2020 budget allocates $220 million for suicide prevention programs. Again, Secretary Wilkie stressed the fact that on average, 20 veterans commit suicide per day, but 14 of those veterans are outside of the VA healthcare system. Therefore, the most important part of the task force, other than a whole-health approach to suicide prevention, is providing money for states and localities to help find those veterans not in the system and welcome them in. Secretary Wilkie also explained that VA will implement a system of education focusing on mental health wellness during service. As such, service members will be taught to look for the warning signs of danger throughout their military careers. In doing so, people will come out of service with some educational grounding in what to look for and when to ask for help for themselves and others. VA looks to work closely with DoD to implement this strategy.